scholarly journals Preoperative biliary drainage versus direct surgery for perihilar cholangiocarcinoma: A retrospective study at a single center

2017 ◽  
Vol 11 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Yulong Cai ◽  
Qi Tang ◽  
Xianze Xiong ◽  
Fuyu Li ◽  
Hui Ye ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Single Center

Biliary Drainage Before and After Liver Resection for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 86 (6) ◽  
pp. 628-634
Author(s):  
Laura M. Enomoto ◽  
Matthew E. B. Dixon ◽  
Allene Burdette ◽  
Niraj J. Gusani
Keyword(s):  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Patient Specific ◽  
Liver Remnant ◽  
Biliary Sepsis ◽  
Before And After

Perihilar cholangiocarcinoma (PHC) is a rare tumor that requires surgical resection for a potential cure. The role of preoperative biliary drainage has long been debated, given its treatment of biliary sepsis and decompression of the future liver remnant (FLR), but high procedure-specific morbidity. The indications, methods, and outcomes for preoperative biliary drainage are discussed to serve as a guide for perioperative management of patients with resectable PHC. Multiple studies from the literature related to perihilar cholangiocarcinoma, biliary drainage, and management of the FLR were reviewed. Commonly employed preoperative biliary drainage includes endoscopic biliary stenting and percutaneous transhepatic biliary drainage. Drainage of the FLR remains controversial, with most experts recommending drainage of the only in patients with an FLR <50%. Biliary drainage for resectable PHC requires a patient-specific approach with careful determination of the FLR and balancing of potential morbidity with the benefits of drainage.

scholarly journals Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases

2015 ◽  
Vol 22 (S3) ◽  
pp. 1156-1163 ◽  
Author(s):  
Jimme K. Wiggers ◽  
Bas Groot Koerkamp ◽  
Robert J. Coelen ◽  
Alexandre Doussot ◽  
Susan van Dieren ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma

scholarly journals Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections

2020 ◽  
pp. 1-8
Author(s):  
Yuzo Yamamoto
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Volume Ratio ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Ligation ◽  
Liver Remnant

<b><i>Background:</i></b> Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. <b><i>Summary:</i></b> FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, <sup>99m</sup>Tc-labeled galactosyl human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either <sup>99m</sup>Tc-GSA or <sup>99m</sup>Tc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. <b><i>Key Messages:</i></b> Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.

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